Personalized Mechanical Ventilation: Improving Quality of Care

In dealing with the unprecedented COVID-19 pandemic, there are an increased number of patients requiring personalized management as the disease pathology varies. With variable lung compliance and airway resistance as well as the severity of the disease, one size will not fit all patients. This book is problem-oriented with evidence-based discussions of the daily encountered scenarios in the ICU for mechanically ventilated patients, dealing with the pathology, monitoring and troubleshooting facing intensivists daily. These scenarios are managed utilizing a goal-directed approach and algorithms to achieve these goals. All chapters contain an explanation of a different solution illustrating the respiratory mechanics, physiology and pathology involved in such a scenario. Each chapter also closes with a take-home message to summarize the content. In addition to describing the ventilation of different patient categories, this text also features ventilation cases specific to COVID-19 including airway management in the enhanced air born isolated patient, pulmonary embolism, different states of shock and differential lung ventilation. There is also a specific chapter on monitoring mechanical ventilation with point of care ultrasound, which is an available modality in most ICUs. Another unique chapter describes how to connect more than one patient to one ventilator in case of a shortage of machines. Written by experts in the field, Personalized Mechanical Ventilation is a timely and valuable resource for critical care physicians, nurses and respiratory therapists on the front lines of both COVID-19 and day-to-day care of mechanically ventilated patients in the ICU. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Timing to perform bed-side surgical tracheostomy in COVID-19 patients in intensive care unit

Background: Tracheostomy is an important surgical procedure in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) pandemic, particularly those patients undergoing prolonged tracheal intubation. The timing and indications for tracheostomy in COVID-19 patients with ventilators are still controversial. Methods: We prospectively studied the best timing for performing surgical tracheostomy in COVID-19 patients (n = 22) from April 2020 to May 2021 in the COVID-19 ICU attached to our COVID-19 hospital. The tracheotomised patients were followed up and the number and timing of the death were documented. Results: There were 14 males (male:female = 1.75:1). The mean duration of endotracheal intubation to tracheostomy was 14.4 days (range 10-22 days). The mean time for tracheostomy was 18.45 min (range 12-25 min). Five patients (22.7%) died after tracheostomy. The median time between tracheostomy and death was 4 days. Conclusions: Surgical tracheostomy has to be performed in a proper time with safe manner for benefit of the patients with COVID-19 and the health care professionals managing the patient. [ FROM AUTHOR] Copyright of Journal of Clinical & Scientific Research is the property of Sri Venkateswara Institute of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

An Unusual Pattern of Dyssynchronous Breathing due to Expiratory Flow Obstruction in the Scavenging System Caused by the Weight of Water Condensate.

BACKGROUND: Patient-ventilator dyssynchrony is commonly due to patient pathophysiologic factors and imprecise ventilator settings. In unusual circumstances, such dyssynchrony can also be due to faults within the equipment preventing from its normal operation during assisted mechanical ventilation. CASE DESCRIPTION: We report a patient showing an unusual pattern of dyssynchronous breathing related to a blocked scavenging system caused by the failure of its rod valve to open. Collection of water condensate inside its reservoir bag leading to a weight drag and deformation of its shape was found to be the cause. Specifically, our patient manifested as failure to trigger with the development of high positive end-expiratory pressure (PEEP) and paradoxical pressure changes during pressure support ventilation. CONCLUSION: Water condensation distal to the ventilator exhaust gas outlet may not be immediately apparent. Clinicians should remain alert with patient-ventilator dyssynchrony, especially with an unusual pattern, as it may signify equipment faults, such as expiratory gas flow obstruction within the scavenging system. HOW TO CITE THIS ARTICLE: Chan KM, Ng YC, So HY. An Unusual Pattern of Dyssynchronous Breathing due to Expiratory Flow Obstruction in the Scavenging System Caused by the Weight of Water Condensate. Indian J Crit Care Med 2020;24(11):1128-1131.